Palliative and Supportive care

EGFRI-Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients about skin problems that may occur when being treated with anti-EGFR drugs

Multikinase Inhibitor Related Skin Toxicity

Information, treatment algorithms and educational materials for healthcare professionals and patients relating to the management of dermatological toxicities in patients treated with multikinase inhibitors.

Drug-Drug Interactions with Kinase Inhibitors

Information and education online resource for healthcare professionals on drug-drug interactions which can arise from the use of kinase inhibitors

Abstract

Introduction

treatment options for glioblastoma at recurrence are various despite the limited efficacy. Surgical resection have been used both for confirmation of recurrent disease as well as for debulking in order to provide relief of symptoms. Therefore, the role surgical resection for recurrent glioblastoma, has not been completely clarified.

Methods

A retrospective analysis was made for glioblastoma patients followed between 01/2005 and 06/2010. Eligibility criteria for the study were: age ≥18 years; PS:0-2; chemotherapy at disease progression after RT/TMZ, availability of data regarding second progression.

Results

232 patients with recurrent glioblastoma (mean age: 52 years, range: 18-77 years, MGMT methylated/unmethylated: 62 [37.6%] / 103 [62.4%]) were evaluated. At progression after RT/TMZ, 102 patients (44%) were treated with re-surgery followed by chemotherapy, and 130 patients (56%) with chemotherapy alone. Overall survival from first surgery was 22.4 moths (95% CI: 20–24.7), being 25.8 months (95%CI:20.6–31) in patients who received second surgery at recurrence, and 18.6 months (95%CI:17–20.1–p = 0.003) in patients treated without surgery. However, in multivariate analysis no significant effect of re-surgery was found (p = 0.11) being age (p = 0.001), MGMT methylation (p = 0.002) and PFS6 (p = 0.0001) the only significant prognostic factors. Moreover, median time between first and second surgery was 13.1 months, being significantly longer in patients with MGMT methylated than in patients MGMT unmethylated (19.3 vs 13 months, p = 0.001).

Median survival time calculated from first recurrence was 8.6 months (95%CI:7.4–9.8), and 9.6 months (95%CI:7.5–11.6) and 7.5 months (95%CI:5.7–9.3) in patients that received second surgery or not, respectively (p = 0.3).

Conclusions

Our data suggested that second surgery may have a limited impact in the clinical course of recurrent glioblastoma patients. MGMT methylation status, as well other clinical factors (i.e. age) remain the major prognostic determinants of the outcome.